DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20201276

Role of video head impulse test to indentify the site of lesion in patients with vestibular neuronitis

Rabindra Bhakta Pradhananga, Bigyan Raj Gyawali, Bebek Bhattarai

Abstract


Background: Vestibular neuronitis is one of the common causes of peripheral vertigo. Mostly the diagnosis of this entity is on clinical grounds. With the advent of video head impulse test (VHIT), assessment of function of all the semicircular canals has been possible based on principle of vestibulo-ocular reflex (VOR). The rationale of our study was to identify the affected branch of vestibular nerve in cases with clinical suspicion of vestibular neuronitis by measuring VOR gain and saccades using VHIT.

Methods: This was a retrospective study carried out in the Department of ENT, Head & Neck Surgery of Institute of Medicine, Kathmandu, Nepal. Record files of patients who attended OPD between October 2017 to October 2018 with the clinical diagnosis of peripheral vestibular neuronitis were assessed. A total of 13 cases were included in the study. VHIT records of the cases were assessed for VOR gain and saccades. Normal contralateral canals were taken as control. Paired t-test was used to compare the statistical significance of gain asymmetry and presence of saccades between the affected side and normal side.  

Results: Of 13 cases, 11 had isolated involvement of lateral semicircular canal and 2 cases had isolated involvement of posterior semicircular canal. Average gain was 0.68 in both groups. Presence of overt and covert saccades was seen in all the affected canals.

Conclusions: VHIT, in cases with vestibular neuronitis, is a good test not only to confirm the diagnosis but also to identify the division of vestibular nerve involved.


Keywords


Vestibular neuronitis, Vestibular nerve, Video head impulse test

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References


Redondo-Martínez J, Bécares-Martínez C, Orts-Alborch M, García-Callejo FJ, Pérez-Carbonell T, Marco-Algarra J. Relationship Between Video Head Impulse Test (vHIT) and Caloric Test in Patients With Vestibular Neuritis. Acta Otorrinolaringol Esp. 2016;67(3):156-61.

Halmagyi GM, Chen L, MacDougall HG, Weber KP, McGarvie LA, Curthoys IS. The Video Head Impulse Test. Front Neurol. 2017;8.

Janky KL, Patterson J, Shepard N. Video head impulse test (vHIT): The role of corrective saccades in identifying patients with vestibular loss. Otol Neurotol. 2018;39(4):467-73.

Association WM. Declaration of Helsinki. Br Med J. 1996;313:1448-9.

Tarnutzer AA, Berkowitz AL, Robinson KA, Hsieh Y-H, Newman-Toker DE. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ. 2011;183(9):571-92.

Büki B, Hanschek M, Jünger H. Vestibular neuritis: Involvement and long-term recovery of individual semicircular canals. Auris Nasus Larynx. 2017;44(3):288-93.

Smith T, Rider J, Cen S, Borger J. Vestibular Neuronitis (Labyrinthitis). In: StatPearls. Treasure Island (FL): Stat Pearls Publishing; 2020. Available at: http://www.ncbi.nlm.nih.gov/books/ NBK549866/. Accessed 9 March 2020.

Cooper CW. Vestibular neuronitis: a review of a common cause of vertigo in general practice. Br J Gen Pract. 1993;43(369):164-7.

Burina A, Sinanović O, Smajlović D, Vidović M, Brkić F. Some aspects of balance disorder in patients with multiple sclerosis. Bosn J Basic Med Sci. 2008;8(1):80-85.

McGarvie LA, MacDougall HG, Halmagyi GM, Burgess AM, Weber KP, Curthoys IS. The Video Head Impulse Test (vHIT) of Semicircular Canal Function - Age-Dependent Normative Values of VOR Gain in Healthy Subjects. Front Neurol. 2015;6:154.

Guan Q, Zhang L, Hong W. Video Head Impulse Test for Early Diagnosis of Vestibular Neuritis Among Acute Vertigo. Can J Neurol Sci. 2017;44(5):556-61.

Taylor RL, McGarvie LA, Reid N, Young AS, Halmagyi GM, Welgampola MS. Vestibular neuritis affects both superior and inferior vestibular nerves. Neurology. 2016;87(16):1704-12.

Yacovino DA, Finlay JB, Urbina Jaimes VN, Verdecchia DH, Schubert MC. Acute Bilateral Superior Branch Vestibular Neuropathy. Front Neurol. 2018;9.

Kim JS, Kim HJ. Inferior vestibular neuritis. J Neurol. 2012;259(8):1553-60.